Tangled in the Safety Net

"Norton" has been staying with the author since being discharged from a hospital in January. It was the only way he could continue receiving the 22 pills he takes each day that keep him alive. The following is the complicated, frustrating story of a man stuck in the social safety net. It's just one example of the battles homeless people face each day trying to survive. Photo by Steven Samra.

Last November I ran into a client I hadn't seen for several months.   Nothing unusual about that, since many folks in the homeless community sometimes up and disappear for a period of time, then pop back up later as if they'd been there all along.

I found "Norton" living in the front section of Nashville's largest Tent City during one of my regular visits to the camp.  This particular area of this camp was at the time known for hard partying and occasionally rough behavior; the camp's controversial order to close on June 1, 2009 arose as a result of a stabbing that occurred in this area over Labor Day Weekend, 2008.  Things have calmed considerably since last summer, but the reputation continues to impact the camp negatively.   

I had gone into Tent City early on this morning to visit and bring supplies to some of the residents.  As I began my walk into the camp, I stopped in at of the more notorious sites in the camp.  A ratty couch, several chairs, an old hospital toilet seat chair and a rickety table surrounded a fire pit, and several people, including Norton, were milling about, in various stages of intoxication. Norton himself was three sheets to the wind and mumbling incoherently, lying in the dirt with a Colt 40 tucked under his arm. 

I pulled up an old lawn chair, grabbed a spot by the fire and began passing out some breakfast burritos and Bugler tobacco to the folks around the fire.  I tried to speak with Norton, but he was barely conscious as I attempted to cajole him into eating one of the burritos.   I could tell he had been abusing himself hard for some time; he appeared gaunt, badly "sucked up" and paler than a piece of chalk.

"Louise," one of the women at the camp, sat Norton up and tried to get him to take a couple of bites of his burrito.  Initially reluctant, he complied when another gentleman at the fire began strongly "encouraging" him to take a bite or he would be cut off from the beer.

As the rest of us chatted, Norton ate about a quarter of the burrito then promptly threw it up into his lap. 

"He's in bad shape, Steve," one of the guys at the fire whispered to me.  "Can you take him to the hospital?" 

"How long's he been vomiting?" I asked.

"About a week, now," he responded.

We got Norton up off the ground, slung his arms around our necks, and dragged him to my car. 

Ten minutes later we arrived at Vanderbilt's Emergency Room and Norton was quickly admitted.

Norton suffers from complications that arise as a result of full blown AIDs; he contracted the disease back in 1989 when a friend of his, jealous that Norton was with the woman he was interested in, left some of his own HIV-infected blood in a syringe and then injected Norton with a dose of cocaine.  The man died a year later and at that point, the woman Norton was with informed him of the sneak attack his "friend" had perpetrated on him.

Norton also suffers from Hepatitis C and a host of other chronic health problems.  He receives social security disability and has Medicare insurance, so he gets treated fairly well at the local hospital.  He's no stranger to many of the hospital staff, either, since he's been in and out of the facility over the past decade with frightening regularity. 

Norton spent 32 days in the hospital on this visit; two weeks of that time was spent in ICU, cathed and in a diaper while physical therapists taught him to talk and walk again.  I visited him several times while he was hospitalized and, since he'd listed me as his "next of kin," I was kept regularly updated by nursing staff as he recovered.

As Norton neared his discharge date, I was contacted by one of Vanderbilt's social workers, who was hoping to find Norton a place to go besides the street.  Fortunately, Norton had been around during the Vulnerability Index (VI) Survey that we performed on the streets of Nashville in the fall of 2008.  The VI is a diagnostic and triage tool that more and more cities are implementing as a way to prioritize care, treatment and service resources to those on the street who need it the most. 

The VI is a powerful tool in many ways. If it's not in your city yet, don't be surprised if it shows up soon.  It generates statistical data that is invaluable in providing information to those who make decisions on how the money for homeless services Is spent. At the same time, it provides focused targeting of exceptionally vulnerable individuals for outreach workers. 

In Norton's case, based on his answers to the questionnaire, he was deemed at "high risk" of dying on the streets if left on those streets much longer, and his name was added to the "priority" list for rapid re-housing.  He was then assigned a case worker from a local agency contracted to assist the most difficult to house clients in the city, based on the VI parameters.

Norton's discharge date arrived and I was contacted by hospital staff to provide a ride for him.  As I discussed particulars with the discharge planner, I was shocked to learn that Norton would not be receiving his medicines.  Flabbergasted, I asked why?  "Well, he is homeless and we don't provide this medication to people who are homeless because it is very expensive. We have found that people on the street aren't able to stay on the regimen needed for the medicine to be effective."

Norton will be the first to tell you that the discharge planner is absolutely correct in her statements. I, too, know all too well that this is entirely accurate.  But I had assumed that once Norton had housing, since he'd been working with an outside agency.

"Norton does not have housing and will be discharged to the street," she told me. 

"Then are you going to keep a bed open for him, ma'am?"  I asked. 

"Why," she responded? 

"Because without those meds, he'll be back in your facility within a week," I scoffed.

"I am sorry, sir, but this is hospital policy."

"Screw that," I told her, he's got housing; I'm providing it for him.  Give him his meds."

I drove to Vanderbilt that day in early January and picked up Norton, who was still frail as a church mouse and able to walk only a couple of dozen feet at a time before having to stop to rest.  We walked- rested-walked across the street and into the parking garage to get to the pharmacy.  We picked up the $3,000 dollars worth of medication he takes monthly in the form of 22 pills and solutions, then went to his impromptu "transitional" housing unit, where we awaited contact from his case manager.

And waited.

And waited.

Finally, after almost a week, we did some investigating on our own (good thing we had a phone, car and plenty of time!), found out who this case manager was, then contacted her ourselves.  It's a damned good thing we made the effort to find her, too, since if she would not have heard or seen Norton within the next two days, she would have dropped him from her caseload.  "We give clients two weeks to make contact; after that, we drop them since there are so many people who need help," she told us. 

"But Norton didn't even know that you or your agency had been assigned to him, since the referral for your services came from yet another agency.  How would he even know to call you," I asked? 

"Well, I left a message posted at the Mission and at the local health clinic for him," she responded.

"But Norton's been in Vanderbilt for the past month and he doesn't use the Mission or the homeless clinic at all," I told her.  "If I wouldn't have been here to help him, he would have been dropped in less than two days," I asked, incredulous.  

"Yep," said she.

Thanks only to that phone call back in January, Norton got to meet with his case manager.  She is a nice enough woman and is really trying to assist him in obtaining permanent housing, but the "pickins is slim," as she told us, and having spent the last two years trying to obtain housing for clients, I know she isn't fibbing. 

Norton has an income, his official documents are complete and in order, he has no background barriers to speak of, he's got references and he's got two agencies, one case manage and one disability advocate working on his behalf.  He's also got access to a phone and transportation, and he still isn't housed as of April 2, 2009.

Imagine then the difficulties facing those individuals on the street who want and deserve housing but have no income, no skills for a job that pays enough to afford even the lowest "market value" rents, and do not have access to, possession of, or enough money to purchase the official documents necessary for admission into public housing.  Here in Nashville, while there is some assistance available in procuring at least some deposits and documents, this assistance is piecemeal and scattered around town.   It is also almost entirely dependent upon who has funds at the moment and who might be able to free up a body long enough to provide the help needed.   Often getting service is so agonizingly frustrating and protracted that people simply give up trying and resign themselves to life on the street.

When one couples these difficulties with the housing situation here in Nashville, I don't hold a lot of hope that anyone, including Norton, will be housed anytime soon.  Affordable housing in the Nashville area is scarce to none and the units that do exist here have two-year waiting lists for them. 

Section 8 assistance has been closed for over a year now (although there was a small window during part of December, 2008 in which MDHA was accepting applications for the vouchers, but it was quickly closed after an avalanche of apps arrived) and has over 4,000 people on its waiting list. 

Shelter Plus Care vouchers are certainly an option, but even with an SPC voucher in hand, one has to find an available unit to enter; otherwise, the voucher itself is no more valuable than toilet paper, and frankly, it's less useful. 

Norton has stopped drinking, regained some weight, is taking his medications regularly and has even stopped smoking as he waits for housing.  He recently visited his doctor, who impressed upon him how lucky he was to have survived his last hospitalization.  The good doc was also more than impressed himself, both with the fact that Norton actually kept his appointment and that he was doing so well overall. 

As of this writing, Norton's spirits are high, but he is quick to tell you that this is because he currently has a roof over his head.  Without shelter, he's certain he'd be in serious trouble.  Norton will also tell you that while he is unquestionably  an alcoholic and drug addict, the days of partying for pleasure are long gone.  Because he receives no pain meds due to the fact that he's "on the street," (pain killers for people who list themselves as "homeless" on an intake form are rare indeed, regardless of the illness or injury) he's been using drugs and alcohol to kill the pain of his AIDs related problems and to combat the depression associated with his life on the streets.  The "fun" of partying died, along with many of Norton's other hopes and dreams, on that fateful day in 1989 and he's been struggling to cope ever since.

By the way, don't tell anyone Norton is currently housed because if those holding the keys to an upcoming housing unit discover this little fact, he would no longer be a priority for rapid housing.  While it's understandable that agencies want to assist those without housing first, this policy ultimately has a perverse side effect; it forces the poor sod to remain in the street in order to obtain housing and penalizes the individual when good Samaritans, family members and/or friends offer temporary shelter to folks on the street, since it seriously impacts and often delays the person's chances of obtaining housing through official channels. 

Norton is eventually going to obtain his housing, although when that occurs is still up in the air.  For the thousands of other individuals currently wallowing on streets across the country, the same cannot be said.   Money from the stimulus plan has been earmarked for rapid re-housing of families, but it remains to be seen whether any additional funding will be provided for single individuals on the street.   

If there's one thing the homeless are used to, it's waiting; let's hope that finally, there will be some light at the end of this tunnel, preferably from a living room window;their living room window.